One of the biggest concerns in the care of our patients is the prevention of blood clots (thrombosis) after surgery. Surgery of the hip and knee, especially, places patients at risk for this condition. We will take all measures possible to lower your risk. Prevention will include: Pneumatic Compression Boots while in the hospital, Early mobilization, and the medication Coumadin (Warfarin).
Pneumatic compression boots are sleeves which help to circulate blood through your legs and should be applied while in the hospital whenever you are lying in bed. Your nurse will place these on your legs for you. If they have not been re-applied after you get out of bed, please call for your nurse to put them back on.
Early mobilization has been shown to decrease the risk of blood clots. For this reason, your nurse and therapist will get you out of bed as much as possible.
Coumadin is a very important part of the prevention (prophylaxis) of blood clots in the legs. This medication acts as a “blood thinner” and makes it more difficult for your blood to clot. This is called anti-coagulation. As you can imagine, this medication needs to be monitored very carefully by a physician. A blood test called the “prothrombin time” or “protime” is performed to make sure that your blood is adequately anti-coagulated (thinned). If the prothrombin time is too low, then your blood will clot quicker and you may be at risk for developing a thrombosis. If the prothrombin time is too high, there is a risk for bleeding.
Coumadin will be started the night of your surgery and will continue for four to six weeks after surgery. After you leave the hospital, you will need to have your blood tested for the prothrombin time either once or twice weekly as determined by your physician. These results will be transmitted to your primary care physician who can adjust your Coumadin dose depending on the results of the test. It is important that you contact your primary care physician after you leave the hospital to make arrangements for blood testing and adjustment of the Coumadin dose. If you do not make contact or if there are any problems, contact Annetta in my office immediately.
The primary symptom of a blood clot is swelling and pain in the calf. This makes diagnosis somewhat difficult since all patients with hip and knee replacement have swelling in the leg. Any sudden or new onset of swelling and pain is suspect and needs to be evaluated. A Doppler ultrasound test often is necessary to detect a blood clot if one is suspected. Please call my office if you are concerned that a blood clot may have formed.
My primary goal is to help ensure that you have a safe and successful surgical procedure. If you have any questions please feel free to call me.